Search

Introduction. Extensive comminuted fractures are associated with tooth loss that ultimately leads to dimensional changes in the hard and soft tissues of the alveolar ridge. Reconstruction of the lost mandibular anterior ridge is very complex due to the natural curvature of the region. Case Presentation. In this case report, the combination of the modified shell technique with autologous bone plates and the guided bone regeneration (GBR) technique was performed on an 18-year-old patient after a comminuted fracture, to ensure new bone formation in the anterior ridge with a natural curvature. After the treatment progressed without complications, three dental implants were placed. Annual cone beam computed tomography (CBCT) images were obtained and evaluated using the GNU Image Manipulation Program (GIMP© 2.10). This allowed measurements of the buccal and lingual bone around the implants, showing the annual bone loss in a twelve-year observation period. Discussion. The treatment of the comminuted fracture and the combination of the modified shell technique with autologous bone plates, the GBR technique, and implant placement can be considered successful. The three dental implants were osseointegrated in 2010, with the buccal bone level averaging 1.31 mm below the implant shoulder and the lingual bone level 1.57 mm above the implant shoulder. In 2021, the measurements showed a bone loss of 0.99 mm at the buccal implant shoulder and 0.69 mm at the lingual implant shoulder. Conclusion. The combination of the modified shell technique with autologous bone plates and the GBR technique is a reliable method to ensure new bone formation in the anterior ridge. The use of CBCT is an excellent method to evaluate bone resorption around dental implants, but due to minimal bone resorption in the observation period, an annual CBCT examination is exaggerated. [ABSTRACT FROM AUTHOR]

Aims: Dentophobia is a well‐know kind of phobia and psychological problem in dentistry. Although patients might suffer from severe oral pain and have serious health complications, dentophobia is still posing a threat to oral healthcare and remains an unresolved worldwide phenomenon. According to estimates, up to 80% of the general population are affected by this condition. Dentophobia is an unpleasant problem with serious consequences not only for patients but also for dentists and the public health system in general. This umbrella review provides a comprehensive overview of the various aspects of dentophoia as addressed in the published literature, and the current level of knowledge concerning their treatment. Methods and results: Based on 35 reviews of the published literature, addressing various aspects of dentophobia and published between 2008 and 2021, this umbrella review was written. The search was based on the PubMed and PsycINFO databases. The extraction was structured by open coding and each aspect of the subject analyzed according to Ritchie and Lewis. Conclusion: We conclude that the evidence concerning the efficacy of the various interventions is still rather weak and there is an obvious need for further research, because of the yet and unresolved challenges and the lack of standardised guidelines to deal with patients with dentophobia. [ABSTRACT FROM AUTHOR]

Background: Bulimia nervosa is an eating disorder resulting in an intended weight loss due to decreased food intake, induced vomiting, or hyperactivity, and is observed frequently between 12 and 25 years of age. One of the complications is early tooth loss. Moreover, since bulimia nervosa patients suffer from increased atrophy of the alveolar processes, oral rehabilitation even with short dental implants may be impossible. In these cases, lateralization or transposition of the inferior alveolar nerve (IAN) followed by implant placement can be useful. Case presentation: A 40-year-old woman with a long-lasting history of bulimia nervosa requested a fixed rehabilitation of her partially edentulous mandible. In 2012, a bilateral IAN transposition approach was performed using piezosurgery, and without any postoperative neurosensory alterations. Two years later, bilateral insertion of each two implants was followed by an inflammatory destabilization of the lower left mandible; subsequent to the implant removal, a fracture occurred, and the latter was stabilized by osteosynthesis plates. In 2017, three additional implants were placed, finally providing the patient with a fixed restoration on five implants. Conclusion: Eating disorders may have a tremendous impact on both physical condition and oral health, resulting in early tooth loss and severe bone atrophy. IAN transposition is a viable treatment option to enable installing fixed prostheses via dental implants, but the latter will clearly increase the risk of inflammation and interruption of mandibular continuity. Close clinical and radiologic monitoring is mandatory to adequately respond to complications such as peri-implant mucositis, peri-implantitis, osteomyelitis, or concomitant fractures. [ABSTRACT FROM AUTHOR]

Bone and soft tissue calcifications can often be visualized on panoramic radiographs, thus leading to presumptive diagnoses requiring further examinations. This cross-sectional study determined the prevalence of suspected carotid artery calcifications, tonsilloliths, calcified submandibular lymph nodes, sialoliths of the submandibular glands and idiopathic osteosclerosis in a Lower Austrian subpopulation. Method and Materials: Digital panoramic radiographs (DPR) taken from 1,042 subjects for other clinical purposes between the years 2013 and 2015 were evaluated, using a standardized template. Chi-square tests and Fisher's exact test were used to evaluate the relationship between the detected calcifications and patient age as well as sex. Results: Radiographic data from 490 men and 552 women (mean age of 49.2 [range 21 to 87] years) were analyzed. Two hundred and twenty calcifications were recorded in 198 subjects (19.0%), of which 100 (50.5%) were female. The mean age of participants with calcifications was 55.8 [SD 14.1] years. Radiopaque structures included carotid artery calcifications (5.7%), tonsilloliths (5.7%), calcified submandibular lymph nodes (3.6%), sialoliths of the submandibular gland (0.9%) and idiopathic osteosclerosis (5.3%) as presumptive diagnoses. In total, 196 calcifications (89.1%) were recorded in patients older than 40 years; no gender-dependent relationship could be revealed. Multiple calcification types were detected in 20 patients (11 women, 9 men). Conclusions: With a prevalence of 19.0% in the study population, calcifications observed on DPR are more spread than previously reported. Thus, with patients of increasing age, DPR should be regarded as an important tool for basic screening of suspicious calcifications necessitating further diagnostic assessments. [ABSTRACT FROM AUTHOR]

Odontogenic myxoma (OM) is a non-metastasizing neoplasm of mesenchymal origin, arising in the tooth-bearing areas of the jaws. When regarding the whole spectrum of differential diagnoses for osteolytic jaw lesions, OM constitutes a benign tumor rarely located in the maxilla. Radiographically, displacement of teeth and frequent involvement of the sinus will be found with advanced maxillary OM. The tumor can be removed by means of several techniques, ranging from conservative measures to extended surgical procedures that differ according to type of bone resection and reconstruction of the defect. This report documents 10 years of follow-up in a patient suffering from a Type IV lesion of maxillary OM; with a radiographically proven growth extending into the right maxillary sinus, the patient underwent a segmental maxillectomy. After a tumor-free period of 5 years, the alveolar ridge splitting technique (ARST) was modified to insert dental implants into the horizontally deficient alveolar ridge of the maxilla, and final rehabilitation by means of a conditionally removable prosthetic reconstruction followed. In this paper, the most striking clinical signs of OM with which the dentist should be familiar are reviewed, and we discuss the advantages of segmental maxillectomy in case of an OM, along with the possibility of using ARST, aiming at prosthetic rehabilitation by placement of dental implants in cases of moderate alveolar ridge deficiency after tumor resection. [ABSTRACT FROM AUTHOR]

• Cemento ossifying fibromas are benign rare odontogenic lesions. • The lesion was surgically removed successfully and the patient has been followed up for 18 years, with no sign of recurrence. • Early diagnosis is key to prevent the large growth of the lesion which often results in multiple tooth loss. • Close follow up is important due to the possible recurrence. • Unusual location of a COF in the maxilla, with the superimposition of a solitary bone cyst. Cemento-ossifying fibromas are rare, benign lesions of the head and neck regions. The origin of these lesions can be traced to the periodontal ligament, because its cells are able to form cement, lamellar bone, or fibrous tissue. A rare case report of a young Caucasian female with a COF is described including follow-ups. She remained untreated for several years despite early radiographic findings of the lesion without a definitive diagnosis. The patient ultimately underwent radical surgery and the whole lesion was removed. The subsequent histological examination confirmed the clinical diagnosis of a COF. Since then, the patient has been under regular clinical and radiological follow-ups. This rare case report of a COF, documented over 18 years, shows the importance of consecutive therapy after radiologic and clinical findings, as such lesions continue growing and may subsequently lead to severe medical conditions. Therefore, complete surgical resection of COFs is advised to achieve good results in terms of health and recurrence. Long-term follow-up of patients is required as recurrences can occur for up to 10 years following treatment. Well-planned radical and wide surgical resection of these lesions has proven not only to be effective in eliminating the aetiological factors, but can also achieve decent bone regeneration and aesthetic results with almost no deformation in the surgical site. [ABSTRACT FROM AUTHOR]

Highlights • Florid cemento-osseous dysplasia (FCOD) is a rare, benign fibro-osseous tumour. • We describe the case of a 39-year-old woman with FCOD and sensory paraesthesia. • Biopsy was necessary for diagnosis to exclude malignancy and relieve the symptoms. • We suggest that the paraesthesia resulted from nerve irritation caused by the FCOD. • To our knowledge, this is the first report of paraesthesia combined with FCOD. Abstract Introduction Florid cemento-osseous dysplasia (FCOD) is a rare, benign, slow growing, multifocal fibro-osseous tumour originating from the periodontal ligament. The lesion is characterised by regular bone-structure replacement with fibrous tissue and dysplastic bone. The initial characteristics of FCOD, depending on localisation, resemble those of periapical lesions of inflammatory origin, potentially leading to misdiagnosis. In the absence of infection signs, the treatment of choice is conservative therapy with antibiotics and regular follow-up examinations. Presentation of case We report the case of a 39-year-old Caucasian woman with sensory disturbance along the inferior alveolar nerve for >2 weeks. The involved teeth were vital and the digital orthopantomogram indicated multiple bilateral periapical brightening. Biopsy was indicated to exclude malignancy and to confirm the FCOD diagnosis with predominantly reactive calcification and cell-rich connective-tissue reaction. The sensory disturbances disappeared after the biopsy. Further conservative therapy included regular radiological examinations every 2 years to prevent surgical intervention due to infection risk. Discussion Sensory disturbances around the nervus alveolaris inferior are well-known complications of dental and maxillofacial operations and of malignant tumours. Sensitivity disorder as a first symptom of fibro-osseous dysplasia has not been previously described. Although uncommon in its clinical behaviour, FCOD was finally diagnosed after thorough clinical, radiological, and histological examinations. Conclusion Paraesthesia combined with FCOD has not been previously described. Correct diagnosis is essential for proper treatment and to avoid further complications even when the clinical symptoms appear unrelated. [ABSTRACT FROM AUTHOR]

Introduction Central odontogenic fibroma (COF) is a rare, benign, slow-growing intraosseous odontogenic tumor, and accounts for 0.1% of all odontogenic tumors. It is often confused with other entities, such as keratocysts, ameloblastomas, and odontogenic myxomas. Complete enucleation followed by curettage is the treatment of choice for COF to ensure the lowest possible chance of recurrence. Case presentation We report the case of a young Caucasian woman with COF that went undiagnosed for several years despite repeated radiologic examinations. Finally, a massive tumor was surgically removed and the wound was curetted. The specimen was histologically confirmed to be a COF. The patient remains under regular follow-up, and thus far there have been no clinical or radiologic signs of recurrence. Discussion This rare case of COF, which was documented over a period of 20 years, has helped us to describe the features of this tumor. It also confirms that adequate surgical treatment can lead to impressive bone regeneration in healthy individuals, as evident from the radiologic findings acquired before, during, and after enucleation of the COF in our patient. Our findings also confirm the view that COF has a favorable prognosis regardless of its final size. Conclusion Early diagnosis is key to successful treatment of COF. The slow but steady increase in the size of a COF with no accompanying symptoms has not been reported previously. To our knowledge, this is the only documented case of a COF that has been under continuous radiologic observation for over 20 years. [ABSTRACT FROM AUTHOR]

Summary: Tissue engineering offers an exciting prospect for reconstructive surgery by replacing missing natural scaffolds with artificial ones. For optimal success the artificial scaffold should provide an environment closely resembling the natural tissue. Little is known about the direct influence of the scaffold on the expression of regulators of bone development, such as transcription factors. The aim of this study was to investigate the influence of the scaffold material on the expression of V-ets erythroblastosis virus E26 oncogene homolog 2 (avian) (Ets2), a key transcription factor in bone biology. Human primary bone precursor cells were seeded in three-dimensional constructs consisting of hydroxyapatite (HA) or poly (lactic-co-glycolic acid) (PLGA). Cells grown on tissue culture polystyrene dishes served as controls. After cultivation for up to 21 days the expression of Ets2 and other important bone-specific genes was assessed by reverse transcription polymerase chain reaction (RT-PCR) and Western Blotting. Ets2 mRNA showed significantly higher expression in controls than in bone-like constructs, and more Ets2 mRNA was expressed in cells grown in HA than in PLGA constructs. At protein level however, Ets2 expression was higher in constructs than in controls after prolonged culture. Our study showed for the first time a differential expression of Ets2 in tissue engineered bone constructs in vitro, demonstrating that scaffold chemistry has an influence on the expression of genes regulating osteogenesis. [Copyright &y& Elsevier]

Objective:To compare a Vienna unilateral cleft lip and palate (UCLP) patient sample with the Eurocleft samples using the GOSLON score, to determine the intra- and interrater agreement between several raters and ratings, and to establish whether training with the original GOSLON models enhances accuracy. Patients and Methods:One hundred twenty-three plaster casts of UCLP patients born between 1970 and 1997, with an average age of 9.2 years and all treated with the same regimen, were rated according to the GOSLON score. Results:Of the patients, 71.5% were ranked GOSLON 1 or 2. Only 8.9% were rated GOSLON 4 or 5. There were no significant differences between the different raters and the ratings. Training with the original GOSLON models increased kappa from 0.57 before training to 0.84 after training. Conclusion:The "Vienna concept" was found to be a good regimen for treating UCLP patients in regard to maxillary growth. Personal training on the original GOSLON models appears to improve the accuracy of rating. [ABSTRACT FROM AUTHOR]

Purpose: Tissue engineering of bone entails the successful interplay between osteoinductive factors, osteogenic cells, their extracellular environment, and an osteoconductive biomaterial scaffold. Naturally produced ceramics, like hydroxyapatite (HA) calcified from red algae, are the most promising materials for use as scaffolds in this field. We hypothesized that extracellular matrix compartments and osteoinductive factors could further ameliorate the bioactivity of the scaffold. Materials and Methods: Osteosarcoma cells with proven osteogenic phenotype (SaOS-2) were cultured onto type I collagen coated (Coll I/HA) and noncollagen coated HA granules (NC/HA) gained from red algae (C GRAFT/Algipore). Cells grown on tissue culture polystyrene dishes (TCPS) were used as controls. Second, SaOS-2 cells cultured on Coll I/HA, NC/HA, and TCPS were treated with recombinant human bone morphogenetic protein-2 (rhBMP-2) in different concentrations (10, 100, and 500 ng/mL). Non rhBMP-2-treated cultures were used as controls. Cultures of both experiments were grown under osteogenic differentiation conditions and after 24, 48, and 72 hours assays for cell viability, apoptosis, alkaline phosphatase activity (ALP), and osteocalcin (OC) secretion were done. Results: Coating of HA granules with type I collagen showed higher cell viability in rhBMP-2-treated and nontreated cells. Supplementation of cultured cells with exogenous rhBMP-2 showed a dose-dependent effect only in the TCPS group. No alterations of the apoptotic rate within 1 investigation group were found. Addition of rhBMP-2 did not significantly alter the specific OC secretion of cells grown on Coll I/HA and TCPS. Conclusion: These in vitro findings show that in the initial period of cultivation and up to 72 hours, the coating of HA granules with collagen type I had positive effects on cell viability and osteoblastic characteristics of osteoblastic cells. In contrast, the supplementation with exogenous rhBMP-2 shows no dose-dependent effects. The combination of collagen type I and exogenous rhBMP-2 did not ameliorate the bioactivity of hydroxyapatite calcified from red algae in the initial period of cultivation. [Copyright &y& Elsevier]

Purpose: The aim of this retrospective study was to evaluate the clinical outcome of fractures of the atrophic mandible based on the degree of atrophy and treatment by different plating systems. Patients and Methods: Thirty patients with 40 fractures of atrophic mandibles were treated by open reduction and internal fixation at our department between 1994 and 2001. Twelve fractures occurred in Class I (between 15- and 20-mm bone height), 10 fractures in Class II (between 10 and 15 mm), and 18 fractures in Class III atrophy (<10 mm). The profile heights of plating systems used for stabilization varied from 0.5 to 2.2 mm and were applied with an intraoral (n = 37) and extraoral (n = 3) approach. Results: In 36 fractures, bone healing was uneventful. Major complications (loose hardware or nonunion) occurred in 4 fractures: 2 in Class II and 2 in Class III atrophy. Major complications were observed with 1.4-mm (n = 3) and 2.2-mm (n = 1) plates. Minor complications (infections or dehiscence) were observed in 6 fractures: 3 in Class II and 3 in Class III atrophy. Hypesthesia of the inferior alveolar nerve was present 1 week and 1 year postoperatively in 39 and 16 fractures, respectively. Conclusions: Treatment of atrophic mandible fractures should be based on the degree of atrophy. More rigid fixation may be necessary in mandibles with less than 15 mm bone height. [ABSTRACT FROM AUTHOR]

Hydroxyapatite (HA) microparticles as a carrier in an injectable tissue-engineered bone filler are considered promising candidates for the treatment of small bone defects in the craniomaxillofacial region. HA granules calcified from red algae, varying in size, were evaluated in vitro for their suitability to be used as a carrier for human mesenchymal stem cells (hMSCs). Three groups of granules were produced in grain sizes of 10–100, 200–500 and 600–1,000 μm. After seeding and culturing hMSCs under osteogenic differentiation conditions onto HA particles for 3, 6 and 9 days, cellular proliferation (tetrazolium salt, XTT), alkaline phosphatase (ALP)-specific activity and total protein synthesis were investigated. The osteoblastic phenotype of the cells was evaluated by assaying the bone-specific genes osteocalcin, osteopontin and collagen type I. XTT assay revealed significantly higher (p < 0.01) proliferation of cells grown on the smallest grain size after 9 days of culture. Regarding ALP-specific activity, significantly higher levels of activity were detected in cells grown on the smallest grain size. Different grain sizes had no significant effects on the secretion of osteocalcin and osteopontin. Collagen type I production was significantly higher (p < 0.05) in cells grown on the biggest grain size in comparison with the two other grain sizes. These results show that the particle size of HA microparticles affects the osteogenic potential of cultured hMSCs and lead to the conclusion that particle size has differential effects on ALP-specific activity and collagen type I production. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the interaction between osteoblast-like cells isolated from mandibular bone and hydroxyapatite ceramic bone substitute obtained from calcified red algae to assess the growth and differentiation of adherent cells on this biomaterial. Materials and Methods: The macroporous ceramic material C GRAFT/Algipore (The Clinician’s Preference LLC, Golden, CO) is composed of 100% hydroxyapatite and possesses specific mechanical and physiochemical properties. Osteoblast-like cells were seeded on 200 mg of biomaterial and cultured for 6 and 21 days under osteogenic differentiation conditions. Specific alkaline phosphatase activity, DNA, and protein content of the proliferating cells were analyzed. The morphology of the cells in contact with the biomaterial was examined by scanning electron microscopy. The osteoblastic phenotype of the cells was confirmed by analysis of the expression of bone-specific genes (osteocalcin, osteopontin and collagen type I) by semi-quantitative reverse transcriptase polymerase chain reaction. Results: The DNA and protein content increased over the culture period. Scanning electron microscopy showed cells spreading on the surface of the biomaterials, covering the macropores, and colonizing the depth of the particles. The analysis of the expression patterns of bone-related genes confirmed the osteoblastic phenotype of the cultured cells. Conclusion: The results of this study showed that hydroxyapatite ceramic bone substitute obtained from calcified red algae support the proliferation and differentiation of human osteoblast-like cells on its surface in vitro and might be suitable for use as scaffolds in tissue engineering strategies in vivo. [Copyright &y& Elsevier]

Purpose: Multifocal motor neuropathy (MMN) is a rare immune-mediated neuropathy causing progressive, asymmetric weakness without sensory loss. Long-term administration of intravenous (IVIg) or subcutaneous (SCIg) immunoglobulins is the primary therapeutic approach. Despite this, therapy failure can result in a decline in strength, particularly in the hands, impacting daily activities. This review and case report presents the current literature on this complex dental and medical topic and explores the novel use of dental implants for full-mouth rehabilitation in MMN patients undergoing long-term IVIg therapy., Materials and Methods: A patient with MMN underwent 15 years of long-term treatment with intravenous immunoglobulin (IVIg), starting with an initial dose of 0.4 g/kg for 5 days every 4 months in 2008. The maintenance dosage of 0.2 g/kg as a single dose every 3 months was established as a long-term therapy. In 2017, the patient received a maxillary and mandibular complete-arch implant-supported prosthesis., Results: MMN showed no progression until the IVIg interval was extended to every 4 months in 2022. Significant deterioration in dental health resulted from a loss of right-hand dexterity, which affected toothbrush use and interproximal brushing, resulting in poor oral hygiene. Dental hygiene and dental health, which were not optimal anyway, were considerably worsened by the loss of dexterity in the right hand, which impaired the use of the toothbrush and the cleaning of the interdental spaces., Conclusion: Dental implants are a well-established treatment for edentulous patients, but their success in those with MMN requires careful consideration of oral health practices. Effective maintenance protocols and optimised prosthetic designs are crucial for long-term implant therapy success in MMN patients. Peri-implant diseases pose risks influenced by various factors. In the case of MMN and its neurological considerations, implications for dental implant provision warrant further exploration, considering clinical symptoms, therapy, and potential progression.